• Golden State Advocates Eligibility

The COVID-19 Provider Relief Fund: What You Need to Know

Updated: Aug 28, 2020

What You Need to Know to Recover Lost Revenue and Help Uninsured Patients Access Coronavirus Testing & Treatment

Providers have until the extended September 13, 2020 deadline to apply for reimbursement through Phase 2 General Distribution funding from the COVID-19 Provider Relief Fund.

Here is what you need to know about this program and how it can provide aid to you and your patients:

What is the COVID-19 Provider Relief Fund?

The Provider Relief Fund (PRF) is a federal program – administered by UnitedHealth Group through a contract with the Health Resources & Services Administration (HRSA) – which has been allocated $175 billion. This money is being distributed to qualified health care service and support providers for appropriate expenses, lost revenue due to COVID-19, and helping uninsured patients access COVID-19 testing and/or treatment.

Both the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) have appropriated money to this fund.

As long as the provider complies with the program’s terms and conditions, payments received from the Provider Relief Fund do not need to be repaid.

How Does Participation Affect Uninsured Patients?

The U.S. Department of Health & Human Services (HHS) website states:

“Providers who participate in and are reimbursed from the HRSA COVID-19 Uninsured Program are not allowed to "balance bill" individuals who do not have health care coverage (uninsured).”

Uninsured patients should contact their provider if they receive any medical bills for COVID-19 testing and/or treatment services that indicate that part of these costs were paid for by the Health Resources & Services Administration (HRSA), because they may not be responsible for the balance.

Uninsured patients may be responsible for payment however, if their provider did not participate in the HRSA COVID-19 Uninsured Program or the care administered was not eligible for reimbursement from the program’s funding. Providers can therefore help their uninsured patients avoid unexpected medical bills by participating in this program.

What are the Requirements for Reimbursement?

Qualifying healthcare costs and services (such as testing for the virus, office visits, telehealth, non-emergency transportation, and more) provided on or after February 4, 2020 to uninsured patients with a primary diagnosis of COVID-19 are eligible for reimbursement.

Key requirements include:

· Screen each patient for insurance coverage to confirm they are uninsured.

· Accept the payment provided from the fund and do not further bill the patient.

· Submit to a post-payment audit.

· Ensure that COVID-19 is the primary diagnosis (except in the case of pregnancy).

Additional conditions:

· Payment is generally at Medicare rates and depends on available funding.

· Claims cannot be repealed or reprocessed after submission.

· Providers must have a clearinghouse or similar relationship to submit claims electronically.

· Providers must attest that the information submitted is true; revenue cycle vendors/billing companies can attest to the accuracy of the information for the provider.

Providers can check the HHS.gov website for updated requirements/deadlines.

We’re Here to Help You are probably experiencing a surge in the number of uninsured patients who need testing and treatment for the coronavirus. The COVID-19 Provider Relief Fund can help limit the financial impact of this crisis on your organization and on your uninsured patients.

Golden State Advocates Eligibility is committed to helping providers and patients through this difficult time. We can screen patients for health coverage and keep you up-to-date on coronavirus rules, regulations, and flexibilities.

For more information on the CARES Act COVID-19 Provider Relief Fund or for help getting started with the application process, please contact us here.


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